Individual
EXTASY GRINN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CAP. ICADC
Contact information
Practice address
2030 CHILHOWEE MEDICAL PARK, MARYVILLE, TN 37804-5285
(865) 982-3400
(865) 238-2034
Mailing address
4799 PALMBROOKE CIR, WEST PALM BEACH, FL 33417-7534
(561) 876-8751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ADC-003288-2014
FL
104100000X
Social Worker
7341
TN
1041C0700X
Clinical Social Worker
Primary
7341
TN
1041C0700X
Clinical Social Worker
SW14806
FL
Other
Enumeration date
12/16/2017
Last updated
07/09/2025
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